Main Drug Of Abuse Research Articles

Review on Toxicological Aspect of Ahiphena (Papaver)

Ahiphena (papaver) is one among Upavisha which is air-dried latex juice obtained from unripe capsules of white poppy. White poppy is botanically classified as Papaver somniferum and belongs to family Papaveracea The name poppy is derived from Latin meaning sleep inducing. The Ayurvedic text Rasa Tarangini Included Ahiphena (papaver) among eleven Upavishas . Opium yields wide range of natural, semi synthetic and synthetic alkaloids namely morphine, thebaine, codeine and papaverine which is commonly use in medicine. Semi synthetic heroin, hydro morphine, oxymorphone, oxycodone and synthetic meperidine, methadone, levarphanol , diphenoxylate, fentanyl, proposophene. Opium and its alkaloids cause drug dependence and it is most commonly abused substances after cannabis. Opioids are the main drugs of abuse in Asia, Europe and much of Oceania. The opium act of 1857 empowers only Central Government to cultivate poppy plants and manufacture opium with the help of farmers authorized by Government. The opium act 1878 prohibits import, export, transportation, possession and sale of opium. The Narcotic Drugs and Psychotropic Substances Act, 1985 includes opium as narcotic and psychotropic substances and consumption of opium and its leads to imprisonment for one year or with fine or with both. Schedule-E (1) of Drugs & Cosmetics Act, 1940 has included opium in list of poisons. This study design to present all toxicological aspect of Ahiphena in Ayurvedic and contemporary View to treat people of opium poisoning and counselling in drug abuse.

Substance Use and Mental Illness among Women Admitted in a Rehabilitation Center in Jos, Nigeria: A 5-Year Profile

Substance use disorder are among the most common public health problems caused by using legal and/or illegal substances. Therefore, this study is aimed at reviewing a five-year profile of women admitted at a rehabilitation center in Jos, Nigeria for substance use and mental illness. This is a retrospective cross-sectional study carried out on 183 females admitted between 2012 and 2017 at a rehabilitation center in Jos, Nigeria. Data collection was carried out from documents note of these female participants. Data were analyzed using SPSS version 22. The mean age of the participants was 38.515.3 years. Almost half of the participants were within the age bracket of 20 – 29 years and married (45.9%). Depressive disorder (36.1%) was the commonest mental disorder in the studied participants. Among those abusing substances, multiple substance use (12.6%) was the most prevalent with alcohol use disorder (9.3%) the main diagnosis among those with substance use disorder. According to the result almost half of the studied participants were young, married and educated females. Depression and multiple substance abuse with alcohol the main drug of abuse was a cause for concern in this population. This portrays significant health and economic consequences and the need for urgent action.

Availability of Illegal Drugs During the COVID-19 Pandemic in Western Germany.

Background: In response to the COVID-19-pandemic, a lockdown was established in the middle of March 2020 by the German Federal Government resulting in drastic reduction of private and professional traveling in and out of Germany with a reduction of social contacts in public areas.Research Questions: We seek evidence on whether the lockdown has led to a reduced availability of illegal drugs and whether subjects with substance-related problems tried to cope with possible drug availability issues by increasingly obtaining drugs via the internet, replacing their preferred illegal drug with novel psychoactive substances, including new synthetic opioids (NSO), and/or by seeking drug treatment.Methods: A questionnaire was anonymously filled in by subjects with substance-related disorders, typically attending low-threshold settings, drug consumption facilities, and inpatient detoxification wards from a range of locations in the Western part of Germany. Participants had to both identify their main drug of abuse and to answer questions regarding its availability, price, quality, and routes of acquisition.Results: Data were obtained from 362 participants. The most frequent main substances of abuse were cannabis (n = 109), heroin (n = 103), and cocaine (n = 75). A minority of participants reported decreased availability (8.4%), increased price (14.4%), or decreased quality (28.3%) of their main drug. About 81% reported no change in their drug consumption due to the COVID-19 pandemic and the lockdown. A shift to the use of novel psychoactive substances including NSO were reported only by single subjects. Only 1–2% of the participants obtained their main drug via the web.Discussion: Present findings may suggest that recent pandemic-related imposed restrictions may have not been able to substantially influence either acquisition or consumption of drugs within the context of polydrug users (including opiates) attending a range of addiction services in Germany.

Understanding Substance Abuse and its Correlation with Social Changes in Sikkim: A Sociological Study

<p>In contemporary society, the full-fledged impact of modernisation and globalisation which has given the free movement of people, goods and money across the countries of the world can be witnessed. This has also opened the economic opportunities among the individuals and communities in the society, which has become a new way of life. Society has changed over the years and activities of the people have also undergone social change. Even the trend of taking drugs has changed with change in society. Traditionally used drugs have been replaced by modern synthetic drugs. The proliferation of pharmaceutical industries, which manufactures narcotic drugs, has, directly and indirectly, encouraged the use and abuse of drugs due to easy access in the market. The epidemic of illicit drug users in the global society has increased significantly and simultaneously related crimes in society. </p><p>Drug abuse is global phenomena. A drug is a biological substance, synthetic or natural, which is taken primarily for non-dietary needs, and it is a substance, which affects the functioning of the mind and body or both. Globally, according to UNODC estimate, in 2009, between 149 and 272 million people, or 3.3% to 6.1% of the population aged 15-64, had used illicit substance once in the previous year. Cannabis and ATS (Amphetamine-type stimulants) are two important drugs which are commonly used worldwide. Within Asia, ATS ranks as the main drug of abuse in Thailand, Japan, Republic of Korea and the Philippines, and also China, Myanmar and Indonesia are in the second rank (UNODC, 2004). Heroin, cocaine and other drugs kill around 0.2 million people each year and also causes health problems with incurable diseases. The European Monitoring Centre for Drug and Drug Addiction (EMCDDA) defines the problem of drug use as, “injecting drug use or long duration regular use of opium, cocaine and amphetamines”. World Health Organisation (WHO), defines drug addiction as a ‘disease,’ and the American Psychiatric Association, define drug abuse as the ‘illicit consumption of any naturally occurring of pharmaceutical substance for the purpose of changing the way, in which a person feels, thinks or behaves, without understanding or taking into consideration the damaging physical and mental side-effects that are caused.'</p>

Oral health status and its determinants among opiate dependents: a cross-sectional study

BackgroundIn addition to numerous general health problems, drug dependents manifest various oral health disorders. Our aim was to investigate the oral health status and its determinants among in-treatment opiate dependents.MethodsAs part of a comprehensive cross-sectional survey on opiate dependents admitted to methadone maintenance centers in Tehran, Iran, we conducted a clinical study in two centers from different socioeconomic areas. A trained dentist conducted face to face interviews and clinical oral examinations based on World Health Organization (WHO) criteria for Decayed, Missing, Filled Teeth (DMFT) index and Community Periodontal Index (CPI) on volunteer patients. Student’s t-test, Mann-Whitney U, Kruskal Wallis, and Chi2 tests, in addition to linear and logistic regression models served for statistical analysis (p < 0.05).ResultsA total of 217 patients (98% men), with a mean age of 43.6 years (SD 12.3) participated in the study. Opium was the main drug of abuse reported by 70% of the participants followed by crystalline heroin (22%). Of the participants, 24.4% were totally edentulous. The mean DMFT score of participants was 20.3 (SD 7.8). Missing teeth comprised the main part of the index followed by decayed and filled teeth. Older patients (p < 0.001) and the patients with a lower socioeconomic status (p = 0.01) had higher DMFT scores. None of the dentate patients had a healthy periodontium. Maximum CPI mostly consisted of shallow pockets (66%) followed by calculus in 15%, deep pockets in 11%, and bleeding in 8% of the participants. Older participants (p = 0.02) and those who started drug abuse at a younger age (p = 0.01) were more likely to develop periodontal pockets.ConclusionsOpiate dependents had a poor oral health status in terms of the dentition status and periodontal health. Missing teeth comprised the main part of their dental caries history and none had a healthy periodontium. Oral health care should be integrated into the package of general health services available in treatment centers.

Research Paper: Patterns of Drunk and Drugged Driving in Fatally Injured Drivers in Tehran, Iran

Background: Substance abuse in drivers is a global public health concern. We investigated patterns of alcohol and illicit drug consumption in drivers died in traffic accidents in Tehran Province, Iran. Methods: In this cross-sectional study, presence of alcohol and illicit drugs in the body of dead drivers referred to Tehran Legal Medicine Organization during April 2016 to April 2018 were investigated. All participants underwent autopsy and their urine, visceral and vitreous samples were examined for alcohol and illicit drugs. Victims with Complete Toxicology Tests for both alcohol and non-alcoholic drugs and those autopsied during their first 24 hours of death were included. Victims’ demographic characteristics, results of their toxicology tests and accident-related factors were investigated, too. To warrant confidentiality of information, identities of victims were concealed. The obtained data were analyzed by SPSS V. 16 and statistically significant level was set at less than 0.05. Results: Of 618 study participants (mean age of 36.95 years), 601 (97.3%) were male. Of victims, 566 (91.3%) were city inhabitants and 471 (76.2%) were with educational attainment of lower than high school. The majority (93%) of crashes happened inside the city. Causes of death were head trauma in 519 (84%) cases, multiple traumas in 62 (10%) cases and bleeding in 37 (6%) cases. Multiple and single-vehicle accidents account for 498 (80.5%) and 98 (17.5%) crashes, respectively. A total of 73 (11.8%) cases were found positive for alcohol/drug consumption: 24 (4%) were alcohol positive, 52 (8.4%) were positive for non-alcoholic drugs (3 were positive for both). Main detected non-alcoholic drugs were morphine and tramadol. There was statistically significant association between drug/alcohol consumption of drivers and cause of death and crash mechanism (Both P<0.001). Multiple traumas and single vehicle crashes were more prevalent among drivers with drug/alcohol positive tests. Conclusion: Rate of alcohol use in our drivers was lower than many countries which is attributed to religious and legal issues. Consistent with the reported pattern of drug abuse in Iranian general population, opioids and tramadol were the main drugs of abuse among studied drivers. Drug or alcohol use result in drivers’ distraction and more fatal injuries.

Efficacy of vortioxetine for patients with dual pathology

IntroductionPatients with dual pathology have worse clinical evolution and worse therapeutic response. Drugs modify the functioning of certain neurocerebral transmission systems, producing cognitive, emotional and behavioral changes. Vortioxetine (Brintellix®) is used as a treatment for major depressive disorder (MDD) and it is considered a new multimodal antidepressant. Preclinical data suggest that the effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine as well as glutamatergic transmission.ObjectivesThis analysis assessed the efficacy of vortioxetine (Brintellix®) in patients with affective disorders and abuse drugs (dual pathology).MethodsEfficacy was assessed with a study of patients who were recruited in a qualitative and observational study. They were treated with vortioxetine (Brintellix®). Outcome measures included changes from baseline to endpoint in Hamilton Depresion Rating Scale (HDRS). They were also interviewed weekly about craving and substance use. Urine test controls were done to corroborate results.ResultsA total of 11 vortioxetine-treated patients improved their depressive and anxiety symptomatology. Seven of them (64%) were males and four of them (36%) were women. Cocaine was the main drug of abuse (n = 9, 82%). The doses were between 5 and 20 mg/day. After the clinical evaluation and 12 weeks of treatment, they achieved to reduce significantly the drug use and verbalized a decrease in craving. Two patients dropped out of the study.ConclusionsVortioxetine (Brintellix®) was shown as efficacious in reducing depressive and anxiety symptoms in patients with dual pathology.Disclosure of interestThe authors have not supplied their declaration of competing interest.

High-throughput dispersive liquid/liquid microextraction (DLLME) method for the rapid determination of drugs of abuse, benzodiazepines and other psychotropic medications in blood samples by liquid chromatography–tandem mass spectrometry (LC-MS/MS) and application to forensic cases

The process of dispersive liquid liquid microextraction (DLLME) was successfully applied for the simultaneous extraction and subsequent ultrahigh performance liquid chromatography–tandem mass spectrometry (UHPLC-MS/MS) determination of many different classes of drugs from whole blood samples. Main drugs of abuse (cocaine and metabolites, amphetamines and analogues, LSD, ketamine, opiates including buprenorphine, methadone and fentanyl and analogues), benzodiazepines, Z-compounds and other psychotropic drugs were effectively extracted in a single step and determined with satisfactory sensitivity, accuracy, repeatability and linearity. The matrix effect obtained was very low for all the analytes (maximum of 26% of ion suppression or 28% enhancement at low concentrations), demonstrating the effectiveness of sample purification. The limits of detection (LODs) varied from 0.05 to 2ng/mL, limits of quantitation (LOQs) from 0.2 to 10ng/mL. Accuracy and precision were satisfactory: %errors spanned from 0.1 to 15% for drugs of abuse and from 0.4 to 18%, at LOQs, for benzodiazepines and other psychotropic drugs. Interday %CV ranged from 2 to 15 % for drugs of abuse and from 0.2 to 18% (at low concentrations) for other drugs. The method was linear for all the studied analytes, giving regression coefficients (R2) always higher than 0.994. The developed method was successfully applied to the analysis of 50 blood samples from forensic cases, allowing determining the presence of different benzodiazepines in 13 cases, of drugs of abuse in 14 cases, and of other psychotropic drugs in four cases.

Study of the Ratio between Morphine-3-β-D-Glucuronide and Morphine-6-β-DGlucuronide in Blood Samples from Heroin Fatalities

In heroin fatalities the diagnosis of the cause of death, based only on chemical and toxicological data, may be particularly difficult; a complete knowledge of the case history is fundamental. Thus, for each case analytical results should be interpreted taking into account also autopsy findings, information from the scene and relevant medical history. In fact wide variability is present in post-mortem blood concentration of morphine (MOR), the main metabolite of heroin, which is usually the most important analytical result for the interpretation of the cause of death. Recently, increasing interest has grown towards the role of the metabolites morphine-3-β-D-glucuronide (M3G) and morphine-6-β-D-glucuronide (M6G) in mediating heroin effects. To this purpose SPE technique was employed to extract MOR, M3G and M6G from autopsy blood samples. Subsequently a LC/MS-MS method for the determination of these analytes was developed, using a gradient elution with a binary mobile phase, the analytes being revealed by means of an ESI-QqQ Mass Spectrometer operating in positive ionization and MRM mode. After validation, the method was applied to twenty-one blood specimens collected from cases of suspected acute narcotism which previously underwent a Systematic Toxicological Analysis (STA) to highlight the presence of ethanol and of the main drugs of abuse and/or their metabolites. The concentration ratios of MOR, M3G and M6G were investigated. The influence of some risk factors, such as the contemporary use of alcohol, methadone or cocaine, was also studied. Some important indications emerged: the ratio M3G/M6G, being quite constant, should be a valid reference value to assess toxicity. Furthermore the value of M3G/M6G ratio detected in heroin addict, in this study, is lower than that found in people who assume morphine for therapeutic purposes. This ratio could be of help to overcome the difficult interpretation of chemical and toxicological data.

Burden of blood transmitted infections in substance users admitted for inpatient treatment in Singapore and the associated factors

There is paucity of local data on the prevalence of blood transmitted infections (BTIs), such as hepatitis B, hepatitis C and human immunodeficiency virus (HIV) infections, among illicit drug users. This study aimed to examine the prevalence of BTIs among substance dependent inpatients and identify the factors associated with BTIs. We conducted a retrospective analysis of clinical notes of 170 inpatients with a diagnosis of substance dependence who were admitted at the National Addictions Management Service, Singapore, between 1 June 2009 and 31 May 2010. Majority of the 170 inpatients were male (88.2%) and Chinese (58.2%). The mean age of the patients was 43.1 years, and the main drug of abuse was opioids (86.5%). BTIs were found in 70 (41.2%) inpatients; the prevalence of hepatitis B, hepatitis C and HIV infections was 3.7%, 39.6% and 0%, respectively. Lifetime intravenous drug use, but not needle-sharing, was more common among inpatients who were positive for BTIs (p < 0.01). Logistic regression analysis showed that lifetime intravenous drug use (OR 4.3, 95% CI 1.7- 10.8, p < 0.01) was the only significant predictor of BTIs. A large proportion (41.2%) of the substance users seeking help was positive for at least one BTI. Lifetime intravenous drug users were found to be more than four times more likely to have a BTI. Early detection and prevention is essential to improve prognosis.

SY24-2 * METH INDUCED PSYCHOSOCIAL DISASTERS: FROM OPIATES TO METHAMPHETAMINES IN IRAN

Opiates were the main drug of abuse in Iran drug scene since at least five centuries, although a new trend of methamphetamine (MA) use have been emerged during recent years. False beliefs (such as non-addictive nature and weight loss) and short term effects (increase of sexual pleasure and improving concentration and overall stamina) as well as other factors such as young population of the country, ease of consumption, and later on, local production and availability of MA in the country were influential on increasing trend towards this type of substances. Iran has implemented a large scale opioid maintenance treatment (OMT) program in response to HIV epidemics among people who inject opioids since 2002. The MA epidemic was superimposed on such a context and elicits considerable public health concerns among policy makers. From one hand MA use is associated with increased psychosocial instability and HIV related high risk behavior; on the other hand it could compromise positive outcomes of OMT programs. In this presentation, the existing data on extend of methamphetamine use and its psychosocial consequences in Iran would be reviewed and the policy implications would be discussed. Language: en

Norjizak Injection: A Critical Risk for Transmitting Blood-Borne Infectious Diseases

Dear Editor, Infectious diseases including HIV and viral hepatitis constitute a major health concern with high prevalences among injecting drug users (IDUs) in Iran (1, 2). IDUs that share needles and syringes and practice sexual behaviors are at risk groups for being infected with blood-borne infectious diseases such as HCV (3). The recent increasing use of opioids in Iran has been strongly associated with health-related harms (4) including transmitting HIV, HCV, and HBV infections (5-9). In 2005, a new illicit opioid, named as Norjizak, was introduced in Iran’s illicit drug market and it gained popularity in a short period of time and contributed to transmitting blood-borne infectious diseases. Norjizak which is also written as Norjizac, Norgesic, and Norchizack in Iran is a narcotic drug which is a combination of several opioids with Dexamethason or Benzodiazepines (10). Its main route of administration is injection. Norjizak is also used intramuscularly and/or subcutaneously. Its injection is associated with several medical complications including abscess formation, development of septic emboli and soft tissue infections in IDUs, but a few studies have focused on Norjizak injection and its health-related problems in Iran (11). A recent study on the patterns of pre-treatment drug abuse, drug treatment history, and characteristics of 810 drug dependent-patients at drug use treatment clinics in Tehran, Iran showed that Norjizak injecting was prevalent as a main drug of abuse among 0.5% of the sample before entry to Methadone maintenance treatment (12). In another study on hospitalized drug users in Loghman Hakim and Imam Hussein hospitals in southern Tehran, a total of 221 patients were studied. The study results showed that 5.4% included injecting Norzijak users (INUs) (13). A research study on 18 male Norjizak-dependent patients with a mean age of 29.8 years who volunteered for treatment at a drug use treatment clinic showed various psychological and physical impacts associated with Norjizak injecting such as striae, weakness, high systolic blood pressure, moon face, hirsutism, extensive dermal infection, gynecomastia, backache, insomnia, lack of potency, and 22.2% of the sample was infected with HCV (14). In a study on infectious complications and mortality due to Norjizak injecting in comparison with other injecting opioids, 690 patients whom were admitted to a hospital in Isfahan city were studied. The study findings showed that 14.5% were INUs. Compared with other groups, Norjizak group was younger and the death rate was 37.5% which was higher than other groups (15). In a study, 14 vials of Norjizak were tested for detecting HCV. Two-hundred micro-liters of the solution in each vial were obtained and using a high pure viral nucleic acid kit, RNA extraction was done. Thereafter, C-DNA was produced by the use of Moloney Murine Leukemia Virus reverse transcriptase (Fermentas, Life Science). Using specific primers and a probe for the detection of HCV (Tagman probe), PCR was done (Corrbette Research 6000). The study results showed that 14% of the vials were positive for HCV (16). Norjizak injecting is a crucial health concern and risky behaviors related to norjizak injecting account for a considerable proportion of incident blood-borne infectious diseases such as HCV. Therefore, treatment interventions and harm reduction programs are necessary to prevent or reduce Norjizak injecting among IDUs. With reducting Norjizak injecting and consequently, decreasing the spread of blood-borne infectious diseases, these programs help both INUs and the community. There is evidence that access to Methadone maintenance treatment (MMT) could be helpful for reducing illicit drug injection and can be considered as a major intervention for preventing from transmitting blood-borne infectious diseases in Iran (17). In recent years, a harm reduction approach has been rapidly developed for IDUs in Iran. Methadone and Buprenorphine maintenance treatment programs have become widespread (18). A study on MMT outcomes in Iran showed that the prevalence of drug injection in the MMT group was lower compared with the control group (16% vs. 100%). There was also a considerable difference in needle and syringe sharing (40% in the control group vs. 4% in the MMT group) (19). In recent years, needle and syringe programs (NSPs) have been also developed to decrease sharing practices among IDUs in Iran (20, 21), but implementing specific harm reduction strategies that specifically target INUs should be considered by policymakers and health providers. The medical and health impacts of Norjizak injecting in Iran are complex and devastating, therefore, extensive research is still required to investigate the effects of Norjizak injecting on general health and transmitting blood-borne infectious diseases. Drug education on Norjizak injecting and its risks for being infected with viral infections such as HCV is essential. Norjizak injecting is a critical health concern among some Iranian IDUs that requires a collaborative and consistent response among all health providers. Treatment interventions and harm reduction programs should be specifically implemented for the current treatment needs of INUs in Iran.

Patterns of pre-treatment drug abuse, drug treatment history and characteristics of addicts in methadone maintenance treatment in Iran.

BackgroundOpiates are the main drugs of abuse, and Methadone Maintenance Treatment (MMT) is the most widely administered drug addiction treatment program in Iran. Our study aimed to investigate patterns of pre-treatment drug abuse, addiction treatment history and characteristics of patients in MMT in Tehran.MethodsWe applied a stratified cluster random sampling technique and conducted a cross-sectional survey utilizing a standard patient characteristic and addiction history form with patients (n = 810) in MMT. The Chi-square test and t-test served for statistical analyses.ResultsA clear majority of the participants were men (96%), more than 60% of whom were between 25 and 44 years of age, educated (89% had more than elementary education), and employed (>70%). The most commonly reported main drugs of abuse prior to MMT entry were opium (69%) and crystalline heroin (24%). The patients’ lifetime drug experience included opium (92%), crystalline heroin (28%), cannabis (16%), amphetamines (15%), and other drugs (33%). Crystalline heroin abusers were younger than opium users, had begun abusing drugs earlier, and reported a shorter history of opiate addiction.ConclusionOpium and crystalline heroin were the main drugs of abuse. A high rate of addiction using more dangerous opiate drugs such as crystalline heroin calls for more preventive efforts, especially among young men.

A Fifty-Year Challenge in Managing Drug Addiction in Malaysia

The history of substance abuse in Malaysia can be divided into pre- and post-independent era. In preindependence, the main drug of abuse was opium which was initially consumed by immigrants from China who were introduced by the British colonialist to work in Malaya. The post-independence era began in the 1960s when young adults were influenced by the “Hippy” subculture. At this time, consumption patterns changed where more Malays were involved in drug abuse compared to other ethnic groups (1, 2).By the early 1980s, the prevalence of drug addiction increased and this increasing trend made the Malaysian government consider heroin addiction as a national threat. The national anti-drug task force was formed to control trafficking and to rehabilitate addicts who were involved in heroin addiction (3). Legislation was introduced where mandatory death sentence was implemented for those who smuggled more than 15 grams of heroin. Drug addicts found to be positive for heroin were forced to undergo compulsory rehabilitation for two years (4). Nationwide, up to 28 government drug rehabilitation centers were established, and at any particular period, each center accommodated up to 500 inmates. Approximately RM50 million a year was spent to run these centers (5). The centers were initially managed on a total abstinence philosophy; however this approach produced poor results. The latest survey showed that 85% of drug addicts relapsed after completing their rehabilitation at these centers (4, 6). In view of the poor results, substitute treatment with methadone was introduced recently to these centers (7).One of the visions of the Malaysian government was to create a drug addiction free nation by the year 2015. However, the increasing number of drug addicts has caused a surge in demand for rehabilitation centers, resulting in the inability of these centers to cope. For example, the number of drug addicts increased by 1% from year 2001 to 2002, but the number of drug addicts detected in year 2003 was 36,996, a 16% jump from the previous year (31,893). Furthermore, the National Drug Agency reported that 45% of the cases were repeat addicts. As for distribution of new cases, by ethnic group the Malays constituted 71%, Chinese 10.6% and Indian 8.2%. The majority (70%) were in the socially and economically most productive age group (20-39 years) and almost 98% of the addicts who occupied these rehabilitation centers were male. Currently, the number of drug users in the country is estimated to be 250,000 but the number is predicted to reach half a million by year 2015 (3, 8-10). The resulting economic, human resource and social loss is not quantifiable as the vacuum left by these people in various employment sectors are currently being filled by migrant workers. Thus, it is evident that the increasing trend in drug addiction poses a threat to the future of the nation (1, 6, 9).

Treating heroin addiction: Bridging the past and future – a Malaysian experience

Malaysia, with a population of 28.25 million, consists of Peninsular Malaysia and the Borneo states of Sarawak and Sabah. Substance abuse has been prevalent in Malaysia since the 19th century. In the early 20th century, the main drug of abuse was opium, which was primarily restricted to Chinese and Indian immigrant laborers who were introduced by British colonialists to work in Malaya (Noorzurani et al., 2008). However, the pattern of consumption changed in the 1970s when heroin became the abused substance of choice and Malays were the main ethnic group involved in heroin abuse compared to other ethnic groups, namely the Chinese and Indians (Noorzurani et al., 2008; Rusdi et al., 2008). By the 1980s, heroin use among Malaysian youth reached national crisis proportions (Navaratnam, 1988; Chawarski et al., 2006). A total of 194,897 drug dependents were registered by the National Anti-Drug Agency (NADA) in 1988; however, at the end of 2004, the numbers of drug dependents were estimated to be between 202,075 and 607,647 (Mahmood et al., 2005). By 2009, the cumulative number of confirmed drug addicts exceeded 300,000 (Sangeeth et al., 2009; Narayanan et al., 2011).

What Does Self-identified Drug of Choice Tell Us About Individuals Under Community Corrections Supervision?

The term "drug of choice" (DOC) refers to substance abusers' preferred drug and this information often adds to the clinical picture of the patient because substance users often meet diagnostic criteria for dependence on multiple drugs. Characteristics such as age, race, marital status, and psychiatric illnesses have been shown to differentiate among individuals with different DOC preferences. However, no studies have examined DOC in the context of criminal behavior and other drug dependencies. The participants (N = 15,475) of a community corrections program, Treatment Alternatives for Safer Communities (TASC), were classified by DOC for the 4 main drugs of abuse (alcohol, marijuana, cocaine, and opioids) and each drug class was compared with the other 3 DOC using binary logistic regression. Alcohol as DOC was associated with being older, white, male, having private health insurance, being medicated for a mental health disorder, and having a criminal history of person offenses. Cocaine as DOC was associated with being older, black, female, attempting suicide, having less than a high school education, living in a shelter or with relatives, being unemployed, being uninsured, being physically and sexually abused, and committing property and court offenses but not person or substance offenses. Marijuana as DOC was associated with being younger, black, male, never being married, and committing substance but not property or court offenses. Opioids as DOC were associated with being white, female, being married, higher education, being unemployed, and being medicated for a mental health disorder. Overall, there were substantial differences between the 4 DOC groups, and the results are commensurate with expectations based on the abuse and dependency literature.

Estimated Liver Fibrosis and its Impact on All-Cause Mortality of HCV-Monoinfected and HCV/HIV-Coinfected Drug Users

Progression of liver fibrosis is associated with the risk of cirrhosis and end-stage liver disease. We aimed to evaluate fibrosis of the liver using three non-invasive indexes (FIB-4, Forns, and Pohl score) and its association with mortality of HCV-monoinfected and HCV/HIV-coinfected drug users. longitudinal study in patients admitted to substance abuse treatment between 1994 and 2006. Socio-demographic data, drug use characteristics, blood samples for laboratory tests, and serology for HIV and hepatitis C virus infections were collected at admission. Patients were followed-up until December 2006 and mortality was ascertained through hospital charts and death certificates. Four hundred and ninety-seven patients were included (83.1% men); median age at admission was 31 years (IQR: 27-35). The main drugs of abuse were opiates (89.5%) and cocaine (8.3%). Thirty-two percent of patients reported daily alcohol consumption. The estimated prevalence of advanced liver fibrosis (ALF) was higher among HCV/HIV-coinfected patients (9.2% to 17.3% depending on the index analyzed) than among the HCV-monoinfected patients (3% to 3.5%). Odds ratio (OR) for ALF were 3.3 to 6.0 times higher in coinfected patients as compared to the HCV-monoinfected. After a median follow-up time of 7.7 years (IQR: 4.1-9.9 years), almost 20% of patients had died. The estimated ALF at admission was associated with an increased risk of death (RR 1.85 to 3.89 depending on the index). Among those with ALF, mortality rates were similar in HCV-monoinfected and HCV/HIV-coinfected patients, as determined by the FIB-4 and Forns indexes. Estimation of liver fibrosis using serum markers may help with clinical decisions to facilitate access to treatment of chronic hepatitis C in this population.

PW01-226 - Relapse related factors in drug dependent patients after detoxification process in an inpatient unit

IntroductionThere are few studies about the characteristics of Substance Use Disorder patients that relapse, defined by restart of the substance use that motivated the intake, after discharge from a Detoxification Unit.ObjectivesTo analyze the percentage of patients who had a relapse in the following 3 months after discharge and to describe their sociodemographic, clinical and therapeutical characteristics.MethodsWe prospectively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2009. Data was gathered at admission on demographic (gender, age), clinical (main abused drug, psychiatric comorbidities, polydrug users) and therapeutical variables (hospitalisation duration, prescribed treatment). Patients were followed up for 3 months and assessed for relapse at 1 and 3 months by clinical interview, alcohol screening test and/or urinalysis. Results from patients with and without relapses were compared.ResultsThe study sample included 103 patients (77,7% men, average age 38,31±9). At month 3, 57,3% of the patients had relapsed. We found significant differences between the relapse and the non-relapse group on the percentage of polydrug users (68,6% vs 31,4%, p=0,05), on heroine as main drug of abuse (76% vs 24%, p=0,05) and psychiatric comorbidities (60,8% vs 39,2%, p=0,04), being psychotic disorders the most frequent. No significant differences were found between the 2 groups concerning therapeutical variables.ConclusionsMore than half of the patients that ended the detoxification process relapsed in the first 3 months. Polydrug use, opiate dependence and having a psychiatric comorbidity might be considered as risk factors for relapse.

Patterns of substance use in male incarcerated drug users in Sri Lanka

The number of illicit drug users incarcerated in Sri Lanka has been growing over the last decade. This paper presents drug-use characteristics and risk-taking behaviours among a group of male incarcerated drug users. An interviewer-administered structured questionnaire was completed by 278 drug users in three prisons in Sri Lanka. The majority (81.3%) of interviewees were aged 25-45 years. Most of them had received low levels of education, and experienced childhood delinquency and a deprived upbringing. Drug use was largely initiated during early adolescence, then continued to chronicity and the development of drug dependence. There was a high incidence (25-35%) of family history of drug abuse. Heroin (98%) and cannabis (54%) were the main drugs of abuse in the past 30 days. Polydrug use was common (75% in the past 12 months). Tobacco and alcohol use were widespread. The prevalence of intravenous drug use was higher than officially reported (15.8% vs. 1%). There was a high prevalence (53%) of risk-taking sexual behaviour. The pattern of drug use was similar to those reported in nearby countries. However, the increasing prevalence of injecting drug use and risk-taking sexual behaviour is a concern. There is an urgent need to develop effective treatment strategies and to prevent the spread of HIV and hepatitis in Sri Lanka.

A FIFTY-YEAR CHALLENGE IN MANAGING DRUG ADDICTION IN MALAYSIA

The history of substance abuse in Malaysia can be divided into pre- and post-independent era. In preindependence, the main drug of abuse was opium which was initially consumed by immigrants from China who were introduced by the British colonialist to work in Malaya. The post-independence era began in the 1960s when young adults were in' uenced by the 'Hippy' subculture. At this time, consumption patterns changed where more Malays were involved in drug abuse compared to other ethnic groups (1,2).